RAMENSKY, Russia Thirty-eight people were killed, most of them in their beds, in a fire that raged through a psychiatric hospital near Moscow on Friday, raising questions about the care of mentally ill patients in Russia.

The fire, which broke out at around 2 a.m. (2300 BST on Thursday), swept through a single-storey building at the hospital, a collection of wood and brick huts with bars on some windows that was home to people sent there on grounds of mental illness by Russian courts.

By mid morning, a few blackened walls were left standing. The roof had caved in on top of the twisted metal frames of what were once beds. Bodies lay on nearby grass, covered with blankets.

Only three people escaped from the fire in the village of Ramensky, 120 km (70 miles) north of Moscow, prompting speculation the patients were heavily sedated or strapped down.

Irina Gumennaya, aide to the head of the chief investigative department of the Moscow region, dismissed suggestions they had been restrained as "rubbish" but promised blood tests to check whether there were high levels of sedatives.

"The wards ... did not have doors, the patients could have escaped from the building by themselves," she said, adding that she believed the most likely cause of the blaze was patients smoking, or perhaps a short circuit.

Health Minister Veronika Skvortsova said none of the patients were strapped down or subjected to "any such measures that would not have allowed them to react quickly," the state-run RIA news agency reported.

President Vladimir Putin called for an investigation of the "tragedy", the latest in a long line of disasters at state institutions that are often ill-funded. Russia's safety record is dismal, accounting for a high death toll on roads, railways and in the air as well as at the workplace.

Psychiatrists said the fire was not the first and would not be the last of its kind.

"(This happened) because of dilapidated buildings in psychiatric hospitals - a third of the buildings since 2000 have been declared unfit, according to health standards," Yuri Savenko, president of the independent psychiatric association of Russia, told Reuters.

Furthermore, junior and middle-ranking staff had miserable salaries and "because of that the staff were asleep", he said.

Legal standards governing Russian psychiatric patients "are on the whole satisfactory and on par with European standards, but compliance with them is very weak," lawyer Dmitry Agranovsky said.

RUSSIA - "THE MADHOUSE"

Putin's critics blamed the state for neglecting its most vulnerable people.

"Terrible news ... Those patients who burned were there because they were forced to have treatment," said Dmitry Olshansky, former editor of Russian Life, an online journal.

"I read all this and I wonder - what does this remind us of? And then I remember - this is our motherland, the madhouse. Flood, fire, bars on windows ... and we cannot deal with it," he said on his Facebook site.

Officials said the blaze consumed the building quickly and fire-fighters had no chance to save any more people - an account that locals disputed, saying fire engines took more than an hour to reach the scene.

"Don't trust anyone who says they (firemen) arrived quickly ... My wife woke me up, we went out on the street with our daughter. Flames were rising high," said a man, who was drinking an early-morning beer at a friend's garage nearby.

More than 12,000 people were killed in fires in 2011 and more than 7,700 in the first nine months of 2012 in Russia, where the per capita death rate from fires is much higher than in Western nations including the United States.

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